Tadalafil and Acamprosate: Can You Take Them Together?

Tadalafil and Acamprosate: Understanding the Interaction

Published: 18 October 2026

If you're taking acamprosate to support alcohol abstinence and considering tadalafil for erectile dysfunction, you may wonder whether tadalafil and acamprosate can be taken together safely. The good news is that no major direct interaction between these two medicines is commonly reported in clinical practice. However, both your alcohol use history and any other medicines you take must be carefully reviewed by a prescriber before starting tadalafil, as heavy alcohol itself can worsen erectile dysfunction and increase the risk of side effects.

What Is Tadalafil and How Does It Work?

Tadalafil is a prescription medicine used to treat erectile dysfunction (ED) in men. It belongs to a group of medicines called PDE5 inhibitors, which work by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused [4]. Tadalafil does not cause an erection on its own—sexual stimulation is still needed for it to work.

Tadalafil is available in two main dosing schedules. The on-demand option (usually 10 mg or 20 mg) is taken at least 30 minutes before sexual activity, and its effect can last up to 36 hours, earning it the nickname 'the weekend pill'. The daily option (2.5 mg or 5 mg) is taken once a day at the same time, allowing for more spontaneity [4]. Both generic and branded versions (Cialis) are available on prescription after a clinical assessment.

What Is Acamprosate and Why Is It Prescribed?

Acamprosate (brand name Campral) is a prescription medicine used to help people who have stopped drinking alcohol maintain their abstinence. It is thought to work by restoring the balance of certain chemical messengers in the brain that are disrupted by long-term alcohol use. Acamprosate does not prevent withdrawal symptoms and is not a cure for alcohol dependence, but it can reduce cravings and the urge to drink when used as part of a comprehensive treatment programme that includes counselling and support.

Acamprosate is usually started as soon as possible after alcohol withdrawal and is taken three times a day. It is generally well tolerated, with the most common side effect being diarrhoea. Because acamprosate is designed to support abstinence, it works best when you are not drinking alcohol at all. Your prescriber will review your treatment regularly to ensure it remains appropriate and effective for you.

The Link Between Alcohol and Erectile Dysfunction

Chronic heavy drinking is a well-recognised risk factor for erectile dysfunction. Alcohol can damage blood vessels and nerves, reduce testosterone levels, and interfere with the signals between the brain and the penis that are needed for an erection [1]. If you are taking acamprosate to maintain abstinence, addressing your alcohol use may itself improve erectile function over time. However, many men benefit from additional support with an ED medicine like tadalafil while their body recovers.

Can You Take Tadalafil and Acamprosate Together?

No major direct interaction between tadalafil and acamprosate is commonly reported in clinical practice or major drug interaction databases. This means that, from a pharmacological standpoint, taking these two medicines together does not usually cause one to interfere with how the other works, nor does it typically create a new safety risk that would not be present with either medicine alone.

However, it is essential to understand that 'no major interaction' does not mean the combination is automatically suitable for everyone. Your prescriber will need to review your full medical history, including your cardiovascular health, blood pressure, kidney function, and any other medicines you take. Tadalafil can lower blood pressure slightly, and if you are taking other medicines that also affect blood pressure, or if you have underlying heart or circulation problems, careful assessment is needed [4].

During your online consultation at Cured Pharmacy, the prescriber will check every current medicine you are taking, including acamprosate, to ensure tadalafil is safe and appropriate for you. You should never start, stop, or change the dose of any prescribed medicine, including acamprosate, without first speaking to the doctor or pharmacist who prescribed it.

What Your Prescriber Checks Before Approving Tadalafil

Before prescribing tadalafil, a UK prescriber will review several important factors to ensure the medicine is safe for you. They will ask about your cardiovascular health, including any history of heart attack, stroke, angina, heart failure, or abnormal heart rhythms, because sexual activity itself places demands on the heart and tadalafil can affect blood pressure [2][4].

Your prescriber will also check your current medicines. Tadalafil must never be taken with nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or recreational drugs known as 'poppers', because the combination can cause a dangerous drop in blood pressure [4]. If you take alpha-blockers for prostate symptoms or high blood pressure (such as tamsulosin or doxazosin), you may still be able to use tadalafil, but you must be stable on the alpha-blocker and start on the lowest dose of tadalafil.

Other considerations include kidney or liver function, any history of priapism (prolonged erection), previous sudden vision or hearing loss, and whether you have any inherited eye conditions affecting the retina. If you are taking acamprosate, the prescriber will also want to understand your current alcohol use, as heavy drinking can reduce the effectiveness of tadalafil and increase the risk of side effects such as dizziness or low blood pressure [1][4].

Medicines That Affect Tadalafil Levels

Certain medicines can increase or decrease the level of tadalafil in your blood. Potent CYP3A4 inhibitors—such as ritonavir, cobicistat (found in some HIV medicines), ketoconazole, itraconazole, and clarithromycin—can raise tadalafil levels, meaning a lower dose may be needed [4]. Conversely, CYP3A4 inducers like rifampicin, carbamazepine, phenytoin, and St John's wort can reduce tadalafil levels and make it less effective. Your prescriber will review all your medicines and adjust the dose or choose an alternative if necessary.

Practical Advice for Taking Tadalafil and Acamprosate

If your prescriber approves tadalafil while you are taking acamprosate, there are some practical steps you can take to use both medicines safely and effectively. First, continue taking acamprosate exactly as prescribed—usually three times a day—and do not skip doses. Acamprosate works best when taken consistently and when you are abstinent from alcohol.

When taking tadalafil, follow the dosing instructions carefully. If you are using the on-demand dose (10 mg or 20 mg), take it at least 30 minutes before sexual activity; if you are on the daily dose (2.5 mg or 5 mg), take it at the same time each day. Remember that tadalafil only works when you are sexually aroused—it will not cause an automatic erection [4].

Avoid heavy alcohol while using tadalafil, even if you are taking acamprosate to support abstinence. Alcohol can worsen erectile dysfunction, increase the risk of side effects such as dizziness, headache, and low blood pressure, and may reduce the effectiveness of both medicines [1][4]. Grapefruit juice can also raise tadalafil levels and should be avoided. If you experience dizziness when standing up, rise slowly from sitting or lying positions, especially when you first start tadalafil or if your dose is increased.

Warning Signs and When to Seek Help with Tadalafil and Acamprosate

Most men tolerate tadalafil well, but it is important to know the warning signs that require urgent medical attention. If you develop an erection that lasts longer than four hours (priapism), seek emergency help immediately by calling 999 or going to A&E. Priapism can cause permanent damage to the penis if not treated promptly [4].

Sudden loss of vision in one or both eyes, or sudden decrease or loss of hearing (which may be accompanied by ringing in the ears or dizziness), are rare but serious side effects that require you to stop taking tadalafil and seek medical help straight away [4]. If you experience chest pain during or after sexual activity, do not use nitrate medicines to treat it—tell the healthcare professional that you have taken tadalafil.

Common side effects of tadalafil include headache, indigestion, back pain, muscle aches, flushing, and a stuffy or runny nose. These are usually mild and temporary [4]. If you experience severe dizziness, fainting, or any other symptoms that concern you, contact your GP or pharmacist for advice. Continue taking your acamprosate as prescribed unless a healthcare professional tells you otherwise, and never stop a prescribed medicine without seeking advice first.

Reporting Side Effects

If you experience any side effects while taking tadalafil, acamprosate, or any other medicine, you can report them via the Yellow Card Scheme at https://yellowcard.mhra.gov.uk/ or by searching for 'Yellow Card' in the Google Play or Apple App Store. Reporting side effects helps improve the safety information available for all patients.

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 18 October 2026]
2. National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 18 October 2026]
3. Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 18 October 2026]

Information on this page is for educational purposes only and is not medical advice. Prescription treatments require clinical assessment by a UK-registered prescriber. Always consult a qualified healthcare professional before starting or changing any medication.